Provider Demographics
NPI:1710271986
Name:MORAN, ERIN KATHLEEN (MD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:KATHLEEN
Last Name:MORAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3808
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27702-3808
Mailing Address - Country:US
Mailing Address - Phone:919-684-2711
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4699
Practice Address - Country:US
Practice Address - Phone:919-684-2711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-06
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2242562085R0202X
MN1069742085R0202X
WAMD609085662085R0202X
IL125059292208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0406480OtherL&I-SEATTLE RADIOLOGY
WA0406473OtherL&I-RADIA REST OF WA
WA0406477OtherL&I-SWEDISH RADIA EDMONDS
WA0406482OtherL&I-EVERGREEN RADIA
WA0406476OtherL&I-RADIA KING COUNTY
WA0406479OtherL&I-SOUTH SOUND RADIOLOGY
WA2123818Medicaid